深圳市新生儿脑卒中多中心现况调查

doi:10.7499/j.issn.1008-8830.2311094

PDF(601 KB)

中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (5) : 450-455. DOI: 10.7499/j.issn.1008-8830.2311094

论著·临床研究

深圳市新生儿脑卒中多中心现况调查

时莉秀¹, 冯晋兴¹, 韦艳芳¹, 路欣茹¹, 张雨茜¹, 杨林颖¹, 何胜男², 陈佩娟², 韩静³, 陈诚³, 涂惠英⁴, 余章斌⁴, 黄进洁⁴, 曾淑娟⁵, 陈晚铃⁵, 刘颖⁶, 郭燕平⁶, 毛姣玉⁷, 李晓东⁷, 张谦慎⁸, 谢治利⁸, 黄梅英⁹, 晏昆山⁹, 应尔雅¹⁰, 陈俊¹⁰, 王艳荣¹¹, 刘亚萍¹¹, 宋波¹², 刘华艳¹², 肖晓冬¹³, 唐红¹³, 王宇娜¹⁴, 蔡茵莎¹⁵, 龙琦¹⁵, 许汉强¹⁶, 王会战¹⁷, 孙倩¹⁷, 韩芳¹⁸, 张瑞彪¹⁸, 杨传忠¹⁹, 窦蕾²⁰, 时会菊²⁰, 王瑞²¹, 蒋萍²¹,深圳新生儿数据协作网

作者信息 +

A multicenter study of neonatal stroke in Shenzhen, China

SHI Li-Xiu¹, FENG Jin-Xing¹, WEI Yan-Fang¹, LU Xin-Ru¹, ZHANG Yu-Xi¹, YANG Lin-Ying¹, HE Sheng-Nan², CHEN Pei-Juan², HAN Jing³, CHEN Cheng³, TU Hui-Ying⁴, YU Zhang-Bin⁴, HUANG Jin-Jie⁴, ZENG Shu-Juan⁵, CHEN Wan-Ling⁵, LIU Ying⁶, GUO Yan-Ping⁶, MAO Jiao-Yu⁷, LI Xiao-Dong⁷, ZHANG Qian-Shen⁸, XIE Zhi-Li⁸, HUANG Mei-Ying⁹, YAN Kun-Shan⁹, YING Er-Ya¹⁰, CHEN Jun¹⁰, WANG Yan-Rong¹¹, LIU Ya-Ping¹¹, SONG Bo¹², LIU Hua-Yan¹², XIAO Xiao-Dong¹³, TANG Hong¹³, WANG Yu-Na¹⁴, CAI Yin-Sha¹⁵, LONG Qi¹⁵, XU Han-Qiang¹⁶, WANG Hui-Zhan¹⁷, SUN Qian¹⁷, HAN Fang¹⁸, ZHANG Rui-Biao¹⁸, YANG Chuan-Zhong¹⁹, DOU Lei²⁰, SHI Hui-Ju²⁰, WANG Rui²¹, JIANG Ping²¹, Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen/Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, Guangdong 518172, China

Author information +

文章历史 +

摘要

目的总结深圳市新生儿脑卒中发病率、临床特征及预后等情况，提高脑卒中新生儿的早期诊治能力。方法由深圳市儿童医院牵头，收集2020年1月—2022年12月深圳新生儿数据协作网组织21家单位收治的新生儿脑卒中36例，分析深圳市新生儿脑卒中发病率、临床特征、治疗、预后等情况。结果深圳市21家医院2020、2021、2022年新生儿脑卒中的发病率分别为1/15 137、1/6 060、1/7 704。缺血性脑卒中占75%（27/36），男性患儿占64%（23/36）。86%（31/36）的患儿在生后3 d内起病，53%（19/36）以惊厥起病。颅脑影像学结果显示，22例（61%）大脑左侧发生梗死，13例（36%）基底节梗死；12例完成磁共振血管成像检查，9例（75%）累及大脑中动脉。29例患儿完成脑电图检查，21例（72%）出现尖波，10例（34%）出现电发作。不同医院对症支持治疗不同。12例（33%）完善新生儿行为神经测定评分，平均得分（32±4）分。共随访27例患儿12月龄左右的预后情况，44%（12/27）的患儿预后良好。结论新生儿脑卒中主要为缺血性脑卒中，多以惊厥为首发症状，多累及大脑中动脉，脑电图多出现尖波，神经发育评分较低，以对症支持治疗为主，部分患儿预后不良。

Abstract

Objective To investigate the incidence rate, clinical characteristics, and prognosis of neonatal stroke in Shenzhen, China. Methods Led by Shenzhen Children's Hospital, the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022. The incidence, clinical characteristics, treatment, and prognosis of neonatal stroke in Shenzhen were analyzed. Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137, 1/6 060, and 1/7 704, respectively. Ischemic stroke accounted for 75% (27/36); boys accounted for 64% (23/36). Among the 36 neonates, 31 (86%) had disease onset within 3 days after birth, and 19 (53%) had convulsion as the initial presentation. Cerebral MRI showed that 22 neonates (61%) had left cerebral infarction and 13 (36%) had basal ganglia infarction. Magnetic resonance angiography was performed for 12 neonates, among whom 9 (75%) had involvement of the middle cerebral artery. Electroencephalography was performed for 29 neonates, with sharp waves in 21 neonates (72%) and seizures in 10 neonates (34%). Symptomatic/supportive treatment varied across different hospitals. Neonatal Behavioral Neurological Assessment was performed for 12 neonates (33%, 12/36), with a mean score of (32±4) points. The prognosis of 27 neonates was followed up to around 12 months of age, with 44% (12/27) of the neonates having a good prognosis. Conclusions Ischemic stroke is the main type of neonatal stroke, often with convulsions as the initial presentation, involvement of the middle cerebral artery, sharp waves on electroencephalography, and a relatively low neurodevelopment score. Symptomatic/supportive treatment is the main treatment method, and some neonates tend to have a poor prognosis.

导出引用

时莉秀, 冯晋兴, 韦艳芳, 路欣茹, 张雨茜, 杨林颖, 何胜男, 陈佩娟, 韩静, 陈诚, 涂惠英, 余章斌, 黄进洁, 曾淑娟, 陈晚铃, 刘颖, 郭燕平, 毛姣玉, 李晓东, 张谦慎, 谢治利, 黄梅英, 晏昆山, 应尔雅, 陈俊, 王艳荣, 刘亚萍, 宋波, 刘华艳, 肖晓冬, 唐红, 王宇娜, 蔡茵莎, 龙琦, 许汉强, 王会战, 孙倩, 韩芳, 张瑞彪, 杨传忠, 窦蕾, 时会菊, 王瑞, 蒋萍, 深圳新生儿数据协作网. 深圳市新生儿脑卒中多中心现况调查[J]. 中国当代儿科杂志. 2024, 26(5): 450-455 https://doi.org/10.7499/j.issn.1008-8830.2311094

SHI Li-Xiu, FENG Jin-Xing, WEI Yan-Fang, LU Xin-Ru, ZHANG Yu-Xi, YANG Lin-Ying, HE Sheng-Nan, CHEN Pei-Juan, HAN Jing, CHEN Cheng, TU Hui-Ying, YU Zhang-Bin, HUANG Jin-Jie, ZENG Shu-Juan, CHEN Wan-Ling, LIU Ying, GUO Yan-Ping, MAO Jiao-Yu, LI Xiao-Dong, ZHANG Qian-Shen, XIE Zhi-Li, HUANG Mei-Ying, YAN Kun-Shan, YING Er-Ya, CHEN Jun, WANG Yan-Rong, LIU Ya-Ping, SONG Bo, LIU Hua-Yan, XIAO Xiao-Dong, TANG Hong, WANG Yu-Na, CAI Yin-Sha, LONG Qi, XU Han-Qiang, WANG Hui-Zhan, SUN Qian, HAN Fang, ZHANG Rui-Biao, YANG Chuan-Zhong, DOU Lei, SHI Hui-Ju, WANG Rui, JIANG Ping. A multicenter study of neonatal stroke in Shenzhen, China[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(5): 450-455 https://doi.org/10.7499/j.issn.1008-8830.2311094

参考文献

1 Dunbar M, Kirton A. Perinatal stroke[J]. Semin Pediatr Neurol, 2019, 32: 100767. PMID: 31813521. DOI: 10.1016/j.spen.2019.08.003.
2 Nelson KB. Perinatal ischemic stroke[J]. Stroke, 2007, 38(2 Suppl): 742-745. PMID: 17261729. DOI: 10.1161/01.STR.0000247921.97794.5e.
3 Dunbar M, Mineyko A, Hill M, et al. Population based birth prevalence of disease-specific perinatal stroke[J]. Pediatrics, 2020, 146(5): e2020013201. PMID: 33115795. DOI: 10.1542/peds.2020-013201.
4 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
5 易受蓉, 罗学荣, 杨志伟, 等. 贝利婴幼儿发展量表在我国的修订（城市版）[J]. 中国临床心理学杂志, 1993, 1(2): 71-75.
6 中华医学会儿科学分会新生儿学组, 中华儿科杂志编辑委员会. 新生儿惊厥临床管理专家共识（2022版）[J]. 中华儿科杂志, 2022, 60(11): 1127-1133. PMID: 36319145. DOI: 10.3760/cma.j.cn112140-20220531-00498.
7 Xia Q, Yang Z, Xie Y, et al. The incidence and characteristics of perinatal stroke in Beijing: a multicenter study[J]. Front Public Health, 2022, 10: 783153. PMID: 35400054. PMCID: PMC8987304. DOI: 10.3389/fpubh.2022.783153.
8 Li C, Miao JK, Xu Y, et al. Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis[J]. Eur J Neurol, 2017, 24(8): 1006-1015. PMID: 28646492. DOI: 10.1111/ene.13337.
9 柯开富. 孕产妇脑静脉及静脉窦血栓形成的诊治[J]. 中国实用妇科与产科杂志, 2018, 34(7): 729-733. DOI: 10.19538/j.fk2018070107.
10 Herz J, Bendix I, Felderhoff-Müser U. Peripheral immune cells and perinatal brain injury: a double-edged sword?[J]. Pediatr Res, 2022, 91(2): 392-403. PMID: 34750522. PMCID: PMC8816729. DOI: 10.1038/s41390-021-01818-7.
11 Sorg AL, Von Kries R, Klemme M, et al. Incidence and risk factors of cerebral sinovenous thrombosis in infants[J]. Dev Med Child Neurol, 2021, 63(6): 697-704. PMID: 33506500. DOI: 10.1111/dmcn.14816.
12 Fluss J, Garcia-Tarodo S, Granier M, et al. Perinatal arterial ischemic stroke related to carotid artery occlusion[J]. Eur J Paediatr Neurol, 2016, 20(4): 639-648. PMID: 27025300. DOI: 10.1016/j.ejpn.2016.03.003.
13 Leon RL, Kalvacherla V, Andrews MM, et al. Placental pathologic lesions associated with stroke in term neonates[J]. Front Endocrinol (Lausanne), 2022, 13: 920680. PMID: 36157451. PMCID: PMC9492924. DOI: 10.3389/fendo.2022.920680.
14 Fluss J, Dinomais M, Chabrier S. Perinatal stroke syndromes: similarities and diversities in aetiology, outcome and management[J]. Eur J Paediatr Neurol, 2019, 23(3): 368-383. PMID: 30879961. DOI: 10.1016/j.ejpn.2019.02.013.
15 Chabrier S, Sébire G. Perinatal inflammation and placental programming of neonatal stroke[J]. Dev Med Child Neurol, 2020, 62(4): 413-414. PMID: 31591709. DOI: 10.1111/dmcn.14375.
16 Ferriero DM, Fullerton HJ, Bernard TJ, et al. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(3): e51-e96. PMID: 30686119. DOI: 10.1161/STR.0000000000000183.
17 Wagenaar N, de Theije CGM, de Vries LS, et al. Promoting neuroregeneration after perinatal arterial ischemic stroke: neurotrophic factors and mesenchymal stem cells[J]. Pediatr Res, 2018, 83(1-2): 372-384. PMID: 28949952. DOI: 10.1038/pr.2017.243.
18 Bruschettini M, Badura A, Romantsik O. Stem cell-based interventions for the treatment of stroke in newborn infants[J]. Cochrane Database Syst Rev, 2023, 11(11): CD015582. PMID: 37994736. PMCID: PMC10666199. DOI: 10.1002/14651858.CD015582.pub2.
19 Ruddy RM, Adams KV, Morshead CM. Age- and sex-dependent effects of metformin on neural precursor cells and cognitive recovery in a model of neonatal stroke[J]. Sci Adv, 2019, 5(9): eaax1912. PMID: 31535024. PMCID: PMC6739114. DOI: 10.1126/sciadv.aax1912.